Testing a decision aid for patients with low-risk chest pain in the emergency room the chest pain choice trial
The primary outcome, selected by patient and caregiver representatives, was patient knowledge; secondary outcomes were involvement in the decision to be admitted, proportion of patients admitted for cardiac testing, the 30-day rate of major adverse cardiac events, and 45-day health care utilization....
| Main Author: | |
|---|---|
| Corporate Author: | |
| Format: | eBook |
| Language: | English |
| Published: |
[Washington, D.C.]
Patient-Centered Outcomes Research Institute
2018, [2018]
|
| Series: | Final research report
|
| Online Access: | |
| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | The primary outcome, selected by patient and caregiver representatives, was patient knowledge; secondary outcomes were involvement in the decision to be admitted, proportion of patients admitted for cardiac testing, the 30-day rate of major adverse cardiac events, and 45-day health care utilization. We also conducted a prespecified analysis to assess the heterogeneity of effect of CPC in potentially vulnerable patient groups. RESULTS: We assessed 3236 patients for eligibility and enrolled 898 patients (451 CPC, 447 UC) from October 2013 to August 2015. Compared with UC, CPC patients had greater knowledge (questions correct: 4.2 CPS vs 3.6 UC; mean difference [MD] 0.66; 95% CI, 0.46-0.86), were more involved in the decision to be admitted (observing patient involvement [OPTION] scores: 18.3 CPC vs 7.9 UC; MD 10.3; 95% CI, 9.1-11.5), and less frequently decided with their clinician to be admitted for cardiac testing (37% CPS vs 52% UC; absolute difference [AD] 15%; P < .001). CPC increased knowledge to a greater degree in White patients compared with non-White patients (11.0% vs 4.8%, AD 6.2%; P for interaction = .018) and in patients with typical numeracy compared with those with low numeracy (10.6% vs 4.7%, AD 5.9%; P for interaction = .025). However, CPC increased physician trust to a greater degree in patients with "low" health literacy compared with those with "typical" literacy (3.7% vs −1.4%, AD 5.1%; P for interaction = .011). CONCLUSIONS: Use of CPC in patients at low risk for ACS increased patient knowledge and engagement and safely decreased health care utilization. All subgroups benefited to a similar extent from use of CPC; White patients and those self-reporting better numeracy had greater knowledge gains, while physician trust increased more in patients with low health literacy There was no difference in the emergency department (ED) length of stay (LOS) between the CPC and UC arms, although CPC patients had a significantly shorter median LOS in the ED observation unit (824.5 [SD = 517.5] minutes vs 920.2 [SD = 482.4] minutes; P = .0305) and underwent fewer tests within 45 days (mean [SD] 5.6 [5.4] CPC vs 6.4 [5.8] UC; P = .0465). No major adverse cardiac events occurred due to the intervention. When assessing the effect of the decision aid in potentially vulnerable patient groups, we observed similar effectiveness of the decision aid to the trial population in the elderly and in those with lower levels of education and less income on the outcomes of patient knowledge, decisional conflict, and involvement in the decision (P for interaction = nonsignificant). BACKGROUND: Patients at low risk for acute coronary syndrome (ACS) are frequently admitted for observation and cardiac testing at a substantial burden and cost to the patient and the health care system. We compared the effectiveness of shared decision-making facilitated by the Chest Pain Choice (CPC) decision aid with usual care (UC) in the choice of admission for observation and further cardiac testing or referral for outpatient evaluation in patients with possible ACS. METHODS: This was a multicenter pragmatic parallel randomized controlled trial conducted in 6 geographically diverse US emergency departments. Participants included adults (>17 years of age) with a primary complaint of chest pain who were being considered for observation unit admission for cardiac testing. Patients were randomly assigned (1:1) to CPC or to UC. |
|---|---|
| Physical Description: | 1 PDF file (51 pages) illustrations |